We are elated and concerned to convey that AB 369 (Huffman) has made it to California Governor Jerry Brown's desk! This is the Pain Step Therapy/Fail First bill that prohibits a health plan from requiring a patient to try and fail on more than two medications before allowing the patient to have the medicine prescribed by their provider. AB 369 also allows the provider to determine the duration of a treatment, not the health plan. Evidently the health plans are vehemently opposing this bill still and trying to get Governor Brown to veto it. WE NEED TO COUNTER THIS AND SPEAK UP! Below are the three main arguments that plans are making against the bill along with reasons as to why the plans are wrong:
AB 369 will not result in costs to health plans or the state:
· According to the CHBRP report on AB 369, most health plans currently require one to two trials for step therapy. AB 369 will only impact the few outlier plans that require more.
· The bill specifies plans do not have to pay for medicine which is not included in their formulary.
· Plans can still manage their costs by charging patients a copay or coinsurance on medicines not covered by their formulary.
· There is no cost to the state for Medi-Cal patients in managed care. The state pays the managed care plans a set capitated amount to cover all services.
AB 369 will not result in an increase in the misuse of addictive pain medicines:
· The protections in current law that regulate how physicians prescribe opioids are not changed by the bill. Plans use step therapy as a way to control costs, not to combat opioid abuse.
AB 369 does not include any mandates, so it does not impact how federal health reform will be implemented in California:
· The bill does not require plans to cover any pain medicine.
We need your help today, can you please have your support letters sent to Governor Brown and Lark Park in his office ASAP, urging them to sign AB 369, telling them what it means to get proper care as a pain patient, you can send all letters to the following address:
Step Therapy (also referred to as fail-first) is one of the many tools employed by health care payers to manage utilization of health care services. In the case of medications, the process usually requires a patient to try medications for his or her conditions in a series of steps.
While the goal of step therapy policies makes sense, the practical reality is often different. As patients, providers, prescribers and advocates, one of our major concerns we all agree on is restricted access to medicine. Step therapy is not in the best interest of patients or the healthcare system because it undermines the provider's medical judgment and undercuts the relationship between providers and patients. Unfortunately, it is driven by cost considerations rather than appropriate patient care. While the goal of step therapy policies for the insurer may seem to make sense to control costs, the practical reality for people with pain is often very different.
Other key members’ contact information below:
Cc: Michael Marcus, M.D. and James Lafferty, Co-Chairs of the Delaware Medicaid Pharmacy & Therapeutics Committee
Other P & T members:
Dr. Anthony Brazen, Medical Director
Public comments/letters should be sent to the Secretary, key legislators and P & T members below:
West Virginia Department of Health & Human Resources One Davis Square, Suite 100 East Charleston, West Virginia 25301 Phone: (304) 558-0684 Fax: (304) 558-1130
NATIONAL ACCESS TO PAIN MEDICATION SURVEY CONTINUES TO DRAW PARTICIPANTS
Since June 2013, more than 6,000 people have opened and taken the Access to Pain Medication survey. Below are a few of the more than 650 comments left by participants who have had difficulty getting their pain medication prescriptions filled following the recent enforcement actions by the Drug Enforcement Administration (DEA) towards reducing illegal use, abuse, and addiction of prescription medicines. All of the survey questions are confidential, and the participants are unknown.
If you are on an opioid pain medication, it is still not too late to participate in this important survey. It is our intention to use this information to help shape a position paper from the National Fibromyalgia & Chronic Pain Association (NFMCPA) regarding access to care following the many changes in the states about insurance benefits and Medicare/Medicaid. The NFMCPA believes the decisions for pain management medications belong between a patient and her/his physician. We are very concerned about people who suffer from the effects of abuse/addiction as well as the people with chronic pain conditions who need access to pain relief. Please send this information to others you may know who have had pain medications denied for fibromyalgia or another chronic pain condition.
Below are comments to the end-of-survey question: "If you have had a pain prescription rejected by a pharmacy, please write a brief explanation of your experience in not being able to fill your prescription for pain medication."
I had been given permission from my dr to take a few extra doses due to an extreme flare-up, but the ins and pharmacy would not fill a couple of days early. I was unable to work because of escalating pain. They unfortunately did not offer any alternatives (calling the dr for approval, suggesting other medication, etc) I had to take to my bed in severe pain until another pharmacy agreed to contact the dr and the insurance company for approval.
Was prescribed 10 Vicodin for a dental procedure, then later in the month was prescribed Vicodin for pain. Since I used a different pharmacy that was near my doctor to get the prescription I was told I was flagged for trying to get an opiate within a month.
The pharmacist refused to fill my prescription and, when asked about it, said he thought I was receiving too many narcotics when in actuality, my doctor and I were trying different kids out for 2 weeks at a time to figure out which ones would work best for me. He even threatened to call the police. It made me feel like a druggie and less of a person. When I got home, I cried.
It happens almost every month. I am told "We are out of this medicine", over and over. The next month, the same pharmacy will be able to fill the prescriptions. then, a month later, "We're out" again. My family and I know our local pharmacists very well, and they know us. I've even seen tears in the eyes of one, as he told me he couldn't fill the prescription because he was "out of it". I know our pharmacists are being honest with us. They know that MD and RA are serious, debilitating conditions, and they are trying hard to fill their customer's pain relief prescriptions, but all tell us that the DEA has cut their orders and forced them to run out. My primary care M.D. has just stopped prescribing any pain medicines due to "pressure from the DEA". They are "on my back and I'm afraid I'll lose everything I've worked for", he told me. The doctors and pharmacists all say the same thing. The DEA is purposely causing the shortage, and intimidating doctors, pharmacists and patients. I am furious about this out of control, government agency and it's inhumane policies.
Well basically....once my doctor wrote my script wrong. I took it to a pharm. and they called me up in front of many people from my community and proceeded to tell me I was early and trying to scam the system because I'm an addict. I then looked at the script and realized the mistake right away and pointed it out to her. She then told me I was lying and sent me away. Then she called EVERY pharmacy in the area and let them know I was coming and some kind of scammer\addict. Which couldn't be farther from the truth. This pharmacist was trying to really mess things up for me and I've never been anything but nice. I follow all the rules and NEVER go early. I have a very serious condition and to be treated this way is UNJUST and UNFAIR!! Something needs to change!! There have been many times where I've been forced to withdraw off my meds just because a pharmacy...not my doctor. That's what's crazy! If my doctor decided I need a medicine, then I do. Period. The withdrawing is horrible and makes me sicker every time I have to go through it. It's torture. And mentally it's torture because I always have to worry what will happen this month....?
I was trying to fill script and was told by about 12 pharmacies that they didnt have any opiods in stock or that the doc was not in the 5 mile radius. It took about 7 days of driving around in pain to find a pharmacy that would take care of me. It was a horrible experience. Also I was put on some black list because I swore in conversation with one pharmacist. Could not fill scrips at Walgreens for 3 months. I felt degraded and humiliated and I went thru withdrawals and it was just awful. My pain got worse and it took awhile to get it back on track.
In the Tampa area a person routinely must attempt to fill prescriptions at numerous pharmacies monthly, there is a broad spectrum of excuses, the normal excuse is that they are out do to an inability get same from distributor due to DEA interference. Fortunately, I have a client whom I did a divorce for, he is a pharmacist, I now am able to fill my prescription; however, I know of people who must go to multiple pharmacy for weeks on end in an effort to fill medication due to the shortage caused by the DEA. A patient at the doctor's ofice told me he had filled just the day before his appointment, which means he went out every day for 29 days, and the pharmacist told him "you basically hit the lottery, we actually have it in stock."